Dementia

Its been a ride that has not reached a destination. Those people who say its the journey, not the destination, do not know what they are talking about.

My mother is descending”has descended”into dementia. My wife and I have noticed little markers along the way over the last year. I questioned my father and like many husbands, many wives, he insisted she was fine; he never noticed anything. He was lying of course, more to himself than to either of us.

There were episodes he could not possibly have missed, things only now coming to light. But any admission by him that Mom was not up to par would be an admission, first, to himself and one he was not in the least prepared to make. This was the woman he married sixty-eight years ago following a blind date and a fast courtship, upon whom he has relied for everything”up to and including her cleaning his glasses every morning”ever since.

Two weeks ago, or is it now three, her hip shattered in four places. Surgery followed. The surgeon made it sound so easy. Since the hip socket was not involved, she would require but a thirty minute operation to pin and anchor and clamp bones in place, followed by four maybe six weeks in a rehabilitation center, then back home”piece of cake.

I knew that elderly patients with moderate confusion suddenly suffering trauma and surgery may emerge from anesthesia in a greater state of confusion. Perhaps they emerge no worse. The surgeon was optimistic”show me one who isnt. My mother did not awaken unscathed. Her confusion swiftly grew so distinct she was unable to participate in therapy, and then began nighttime rages of shrieks and howls and daytime spaces filled with blank recognition.

She no longer knows me. She remembers the name but can no longer recollect the connection nor place my vaguely familiar face. She makes a heartbreaking plea reaching for my hand, please, would I please tell Russell to come for her and take her from this place . She is living an eternal moment no longer bounded by tomorrow or yesterday. She knows not where she is; she knows only that she wants him to come for her. She repeatedly asks, will I promise to tell him.

My father, ninety, who just retired last June, shrinks in upon himself as I discuss Medicare limits and asset spend-downs necessary to qualify for Medicaid, and he becomes uncharacteristically passive when we discuss which of us should be appointed guardian as we confront future medical and financial decisions. I explain to him, she will not be able to return home. He knows that, he says brusquely. He has that figured out.

I leave in snow with a forty-minute drive home ahead of me, and he tells me in a voice I have not heard since my late teenage years when driving to college, I am to call him so he will know I arrived safe. And like in my teenage years, I forget; he calls and chews me out, a comfort I thought I had outgrown.

Dont ask how I am holding up. I have watched sons and daughters, husbands and wives more or less disintegrate in periods like this, and painfully speculated how I would react. With my parents I have sought retreat into the role of a pastoral clinician, seeking a cool, cool zone of professional detachment. It works best with the lawyer and the nursing home social worker and the customer service representative at the bank. Otherwise”it isnt working very well at all.

Visions of mortality dance in my head. St. Paul said death is the final enemy. True enough as far as it goes, but he made little mention of the others, far worse, we encounter on the way. Death, that isnt a problem. If we go to sleep one night and wake up dead, thats hardly a problem at all. But this journey is a journey of aging, a ruthless, irrevocable thrashing of faculty, facility, a not infrequent plummeting tumble into a loss of identity and sense of self. We, each of us, are bodies of flesh moving through time falling, flying, or tumbling in turmoil aging implacably unto death.

Yet we are more than that. To us, the psalmist recalls, He has given the works of His creation and made us only a little lower than the angels. Oh, the old hymn prays, let me not forget . . . .

Russell E. Saltzman is pastor of Ruskin Heights Lutheran Church, Kansas City, Missouri. He was associate editor of First Things during his parish sabbatical in 2009 following the death of founding editor Richard John Neuhaus. His previous On the Square articles can be found here .